Helena Lööf

Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis

Objectives: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA). Method: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed. Results: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26–1.91] and having a below average income (OR 1.35, 95% CI 1.12–1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40–2.84) and poor health (OR 1.59, 95% CI 1.10–2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35–0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52–0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke’s R2). Conclusions: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

Body awareness in persons diagnosed with rheumatoid arthritis

Living with rheumatoid arthritis (RA) poses physiological and psychological demands on a person. RA is a autoimmune disease that can cause pain, disability, and suffering. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a persons health. The concept of BA is complex and a thorough understanding is needed about what BA means from the patients perspective. This study was therefore conducted to acquire greater insight into this phenomenon. The study is grounded in a phenomenological life-world perspective. Eighteen narrative interviews were conducted in patients (age range 23–78 years) with RA. The interviews were analyzed using the Empirical Phenomenological Psychological method. General characteristics were found running through all 18 interviews, indicating that the disease resulted in a higher degree of negatively toned BA. BA was either a reactive process of searching or controlling after disease-related symptoms or a reactive process triggered by emotions. BA was an active process of taking an inventory of abilities. All participants had the ability to shift focus from BA to the outside world. Four typologies were identified: “A reactive process on symptoms,” “A reactive process on emotional triggers,” “An active process of taking an inventory of abilities,” and “A shifting from BA to the outside world.” In conclusion, because BA can be both positively and negatively toned, health care professionals must have a good understanding of when BA is positive and when it is negative in relation to the patient. RA had caused a higher degree of negatively toned BA. Thus, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patients general health.

‘This is why I’m doing a lot of exercise’ — a qualitative study of participant’s experiences of the Sophia Step Study

Introduction: Support for physical activity (PA) is central in diabetes care. The Sophia Step Study is a three-armed randomised controlled trial aiming to evaluate different levels of support for increased PA in prediabetes and Type 2 diabetes. With the purpose to reveal the programme components and the mediating factors from the participants’ perspective this paper aims to report a qualitative exploration of adhering participants’ experiences after two years’ study participation. Methods: Semi-structured interviews were conducted with 18 participants (men, n = 11, women, n = 7, prediabetes, n = 5, Type 2 diabetes, n = 13, median age 68.5 years) who completed a two-year multi-component (n = 7), single-component (n = 6) intervention or served as controls (n = 5) at a primary care center in Stockholm, Sweden. The interviews were analysed using content analysis with an inductive approach. Sophia Step Study is registered at ClinicalTrials.gov with Identifier: NCT02374788. Results: The participants recalled the frequent study assessments as providing feedback of health outcomes; positive reinforcement; a sense of sentinel and a personalised approach. Group meetings, pedometers and health check-ups were valued as resources for increased awareness and motivation of PA; establishment of new routines and control over the own health. The long program duration allowed for maintenance of awareness and routines for PA Conclusion: Adhering participants in theory-based interventions, but also in the control group, identified key mediators to support for PA. Feedback of results, personalised encouragement, emotional support and self-monitoring should be regarded in self-management of PA to optimise patient motivation and outcomes.

FRI0623-HPR Body Awareness in Persons Diagnosed with Rheumatoid Arthritis

Background Living with rheumatoid arthritis (RA) poses physiological (1) and psychological demands on a person (2). RA is a autoimmune disease that can cause pain, disability, and suffering (1). The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a persons health. The concept of BA is complex (3) and a thorough understanding is needed about what BA means from the patients perspective. A phenomenological study (4) can complement purely medical and psychological perspectives with a holistic understanding. Objectives The objective of this study was to gain a deeper understanding from the patients perspective about the phenomenon of BA. Methods Eighteen narrative interviews (the interviews lasting on average about 75 minutes) were conducted with patients aged 23-78 years, 2 males and 16 females with RA. Disease duration was from 6-34 years. The interviews were analyzed using the Empirical Phenomenological Psychological method (4). Results General characteristics were found running through all the 18 interviews having to do with the fact that the disease had given rise to a higher degree of negatively toned BA. BA was a reactive process of searching or controlling after disease-related symptoms, or a reactive process that was triggered by emotions. BA was an active process of taking an inventory of abilities. Finally, all participants had the ability to shift focus from BA to the outside world. We found four typologies: “A reactive process on symptoms”, “A reactive process on emotional triggers”, “An active process of taking an inventory of abilities” and “A shifting from BA to the outside world”. Conclusions BA can be both positively and negatively toned. Hence, health care workers must be able to understand when BA is positive and when it is negative from the patients perspective. RA resulted in a higher degree of negatively toned BA. Therefore, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patients health. References Symmons, D.P. (2002). Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Practice & Research. Clinical Rheumatology, 16, 707-722. Lutze, U., & Archenholtz, B. (2007). The impact of arthritis on daily living with the patient perspective in focus. Scandinavian Journal of Caring Science, 21, 64-70. Mehling, W.E., Gopisetty, V., Daubenmier, J., Price. C.J., Hecht. F.M., & Stewart. A. (2009). Body Awareness: Construct and Self-Report Measures. PLoS ONE, 19. [Adobe Digital Editions version]. DOI: 10.1371/journal.pone.0005614. Karlsson, G. (1993). Psychological Qualitative Research from a Phenomenological Perspective. Stockholm: Almqvist & Wiksell. Acknowledgements We would like to thank all the patients who participated in the individual interviews. Disclosure of Interest None declared

Fear-avoidance beliefs of physical activity in adults with rheumatoid arthritis

Background A minority of people with RA perform maintained health enhancing physical activity (HEPA). Psychosocial factors seem to be the most salient and consistent factors to explain HEPA variation [1]. Furthermore, avoidance of physical activity could result in negative physical consequences and in psychological changes [2]. The Fear-Avoidance Belief Questionnaire (FABQ) seems to be the best available instrument to measure the concept of fear and avoidance behaviors of physical activity [3]. Objectives The objective of this study was to describe fear-avoidance beliefs of physical activity and explore how they correlate to socio-demographic, disease-specific and psychosocial factors in adults with RA. Methods This cross-sectional study is a part of a study focusing physical activity (the PARA 2010 study). The present study included 2351 patients from six rheumatology clinics. The participants answered the modified version of the FABQ and questionnaires on socio-demographic, disease-related, and psychosocial factors. The statistical analysis, performed in two steps, was aimed to evaluate factors associated with fear-avoidance beliefs. The model fit was estimated using Nagelkerkés R2. Results High level of pain (OR 1.99 95%, CI 1.40 - 2.84) and poor health (OR 1.59, 95% CI 1.10 - 2.29) were the two disease-specific factors most indicative of high mFABQ. Being male (OR 1.55, 95% CI 1.26–1.91) and having a below average income (OR 1.35, 95% CI 1.12–1.63) were associated with an increased risk of high fear-avoidance beliefs. Regarding psychosocial factors, low health related quality of life, HRQoL (OR 0.44, 95% CI 0.35–0.55) and low exercise self-efficacy, ESES (OR 0.66, 95% CI 0.52–0.82) were significantly associated with high fear-avoidance beliefs (Nagelkerkés R2 0.27). Conclusions High fear-avoidance beliefs in patients with RA were associated with being male, below average income, high level of pain, poor health, low health related quality of life and low exercise self-efficacy. The present findings indicate that such beliefs about physical activity are complex and multidimensional. References Demmelmaier I, Bergman P, Nordgren B, Jensen I, Opava CH. Current and maintained health-enhancing physical activity in rheumatoid arthritis: a cross-sectional study. Arthritis Care Res (Hoboken). 2013;65:1166-76. Turk DC, Monarch ES. Biopsychosocial perspective on chronic pain. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management: a practitioners handbook. New York: Guilford; 2002. Lundberg M, Grimby-Ekman, A, Verbunt, J, Simmonds MJ. Pain-related fear: a critical review of the related measures. Pain Research and Treatment 2011; 494196. doi: 10.1155/2011/494196. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1244

Psychometric testing of the body awareness questionnaire in an Swedish sample of patients diagnosed with rheumatoid arthritis

Background The concept of body awareness has come into sight as a subject of scientific research and it has been suggested to be useful in the management of chronic disease [1]. The Body Awareness Questionnaire (BAQ) is an 18-item scale to measure self-reported attentiveness to normal body processes [2]. It has been identified as an instrument with strong psychometric properties [1]. However, there is no validated Swedish version available. Objectives To develop and to test the psychometric properties of the Swedish version of the BAQ for measuring bodily focused of attention in a population of patients diagnosed with rheumatoid arthritis (RA). Methods The study employed a cross-sectional design and a psychometric validation study was developed. The study population consisted of a convenience sample of 120 patients with RA. Psychometric testing included concurrent think aloud method (n=10) to investigate usability and to understand how the patients’ perceive and interpret the questions in the BAQ and Cronbachs alpha coefficients was used to test the internal consistency. Confirmatory factor analysis of the data was conducted using the sem package in R to test the factor structure to investigate the construct validity. Results The majority of the participants’ were able to comprehend (= understanding) all the items in BAQ 1-18, retrieve (=retrieval) all the necessary information from long-term memory, make a judgment (=judgment) about the information needed to answer the items in BAQ, and respond (responding) to the statements in the BAQ item 1-18. Cronbach’s alpha of the overall BAQ 18- item was satisfactory 0.90 in the RA sample. The result of the CFA indicate that the one-factor model have most adequate fit with CFI=0.747 compared to CFI=0.560 for four-factor model. Conclusions The one-factor model displayed the most acceptable fit of the Swedish version of the BAQ. Although further testing of the BAQ scale with different sample is necessary. References Mehling. W.E., Gopisetty. V, Daubenmier, J., Price. C.J., Hecht. F.M. & Stewart. A. Body Awareness: Construct and Self-Report Measures. PLoS One. 2009; 4: e5614. Shields S. A., Mallroy M. E., & Simon. A. The body awareness questionnaire: reliability and validity. Journal of Personality Assessment. 1989; 53: 802-815. Disclosure of Interest None Declared